Sunday, October 27, 2013

12-Hour Challenge 10/27/2013

The prompt was to imagine a dream job - one you want, or one you see someone in and think, "Man. They've got it made!" Imagine that job, and then imagine a bad day at that job.

There's a part of me that has been wishing and wishing that instead of getting some liberal arts degree and remaining comfortably lodged in my government career, that I had gotten out of the Navy and gone to medical school. I'd be in Syria now, patching people up. Being under constant strain. Missing the crap out of my family, but making sure someone else's family members would make it.

It wasn't hard to imagine the bad day - there were so many options to choose from.

-Djinn

---

I was halfway through my 12-hour shift. It had been the
normal things; what you expect in a situation like this: lots of gunshot wounds,
no shrapnel unless there’s an explosion. Today it was thighs, and I was
grateful and angry, but mostly grateful. So long as they missed the femoral artery
and the femur itself wasn't too badly splintered, these guys were mostly going
to make it. Guys, Jesus. Kids. Women. Children. And guys. But mostly not. I had
talked to my colleagues, and it wasn't just my imagination: those bastards are
targeting civilians, and they're playing a game: throats one day, thighs the
next. Three days ago it was shoulders.

Good days are few and far between. I had a good day a couple
of weeks ago. Everyone I saw, I had the supplies I needed to treat them. No one
came in that unexpectedly didn't make it. Only two were too far gone to save
(one kid had died on his way here). More folks walked out of here than walked
in, freeing desperately needed beds. All the needs are desperate. Not enough
beds. Not enough medicine. Not enough people. Never enough people. It just
never quits.

Yesterday wasn't too terrible, but it wasn't a good day. No
big explosions, but also no miraculous cures. We got supplies in two days ago,
so nothing was too short… it’s just, like I said, yesterday it was throats. Lots
of sewing esophagi back together, and more blood transfusions than I can count.
Remove foreign bodies. Stitch lacerations. Close wounds. Scrub. Throats bleed a
lot, even if the bullet manages to miss the major arteries. One was a little
kid. The guy who brought her in said she had been trying to get to school. Her
dad didn't make it; she’s still here. Such a tiny little throat, and so much
damage.

Normally, I work at an inner-city hospital as an emergency
surgeon. I'm a general surgeon, so, I have to be ready to do surgery on
anything. It’s not like my college friends, who specialized in orthopedic surgery
– they get to work 9-5, weekends and holidays off most of the time, they rarely
see anything too terrible, or something that can't be fixed.

“Hey, Doc.” It’s Ziyad, one of the nationals working with us
as a nurse. He had joined up about a month ago.

“Another arrival? I swear I'm almost done…” I had
been plowing through the plate of whatever that I was given in the cafeteria
tent. It’s usually rice with some chicken or beef or something and some lettuce
and tomatoes. I'm pretty laid back most of the time, but I’m hard and fast
about my eating. I need the nutrients to keep going, to keep saving life after
life, so I insist on meal breaks when needed.

“Naw – it’s still quiet. Just hoping you had a cigarette?”

I passed him one. I don't smoke in the states. Shifts in my
ER are 12 hours on and 12 hours off, and after three shifts on, you get some
days off. There’s usually a good bit of down-time during a shift. There’s never
the kind of carnage there is out here. And back in the states… People look at
you funny, if you smoke wearing scrubs. Here, everyone smokes, and they smoke
all the time.

One of the guys I was in med school with was from Sudan. His
parents moved to Chicago when he was in high school. They got into an accident
in their first week in the states, and were astonished at the quality of the
hospitals here. He kept saying how much he wished they had that level of care
back home. We found out about Doctors Without Borders and I just knew we had to
sign up. We come out for 6 months, and go home for 6. He and I happen to be
off-set – Idris left last month and was replaced with Eric.

I put my Styrofoam plate in the trash bag tied to the
tent-pole, drained my water-bottle, grabbed another one and headed outside. May
as well smoke while there’s time.

The suddenness of the explosion made me stumble. Yup.
Exactly enough time for a cigarette and a scrub-down. Eric ran past me, yelling
something about scrubbing. He'd get used to it, eventually. Hopefully, sooner
rather than later – his high-strung jumpiness was wearing on my patience, and I
worried about his ability to focus during surgery. You have to find your Zen
place. The place where nothing else matters besides fixing the brokenness in
front of you as fast as you can.

I finished scrubbing up just as the victims started coming
in. The nurses that were working with us may have started off lacking some
training, but nothing will get you up to speed like disaster. After two years,
we had the routine down. Eric and I would move from bed to bed at the direction
of the nurses – mostly nationals – who would have triaged the victims. I took a
steadying breath, found my Zen place. Remove foreign bodies. Stitch
lacerations. Close wounds. Scrub.

Remove foreign bodies. Stitch lacerations. Close wounds.
Scrub. At some point, I realized there were more of us. The other two surgeons
must have woken up because of the blast and come in. Anything big like that,
and it’s not like you'd be sleeping anyway. Remove foreign bodies. Stitch
lacerations. Close wounds. Scrub. Extra-long days for everyone.

Ziyad, the guy who had bummed a cigarette earlier, started
walking me to the next victim.

“Allah al-musti’an,” he muttered as we passed the still-long
line of victims waiting to be triaged. God help us indeed. “We are drowning in
these Shi’a,” he lamented as we prepared for the next surgery. I shot him a
sharp look – bringing sectarian bias into the environment was strictly
forbidden – but the look was all there was time for. Remove foreign bodies.
Stitch lacerations. Close wounds. Scrub.

I passed Eric, working furiously on an abdomen. Had he found
his Zen place? He looked pale and scared. So did the surgeon from the other
shift working on an arm across from him. Did I look like that, too? Remove foreign
bodies. Stitch lacerations. Close wounds. Scrub.

I glanced at the clock, but it didn’t make sense. The
numbers couldn’t mean anything. Remove foreign bodies. Stitch lacerations.
Close wounds. Scrub.

The next victim just had a little shrapnel in his lower
legs. The nurses probably could have handled this. Remove foreign bodies.
Stitch lacerations. Close wounds. Scrub. And then it was over. The remaining
victims all had very minor injuries that the nurses were wrapping up.

I went out for a cigarette with Ziyad and Eric and a couple
of others and tried to make sense of my watch. It took a few drags, but I
figured it out. I had been on shift for almost 16 hours. I had eight hours to get
home, shower, and sleep before the start of my next shift. I left Eric and
Ziyad, and dragged myself to my near-by apartment.

Something was niggling at me, but I was too tired to put a
finger on it.

My eyes had only been closed a moment when my alarm went off,
followed by the call of the muezzin. Dawn already. I grabbed an energy shot
from my stash, and put another two into my pockets. I got to the hospital and
started checking up on the folks who had stayed overnight. Everyone was doing
well, but this environment wasn't nearly as sterile as it should be – they'd
need to be watched closely for signs of infection.

“Hey, Eric.” I greeted my shift-mate. He looked even more
tired than I felt. I considered what he'd be like, wound as tight as he already
is, with an energy shot piled on top, and tossed him one anyway. “Crazy day,
huh?”

“Yeah.” Eric looked thoughtful, for once more concerned than
panicked. “All these attacks… You think all these folks are shi’ites? I mean,
it seems like in Iraq, it’s all divided by neighborhood. Do you think it’s like
that here?”

“I don't know.” I hadn't been keeping up with the news as
well as I should have been. “This area? I don’t think so. Maybe it’s getting
that way? But I'm pretty sure not all of these victims are Shi’ites. Why?” That
niggling feeling was back. Something was off.

“Oh. Something someone said yesterday.”

“Jeeze. You remember yesterday? It’s still all such a blur.
What do you think today will be?”

Eric looked unhappy. Maybe a poor choice of small-talk on my
part. “I guess we'll find out.” He downed the last of his energy shot and I
took a last drag as a car sped into the lot nearest the hospital. It looked
like arms, maybe hands. It’d be a lot of work, but fewer casualties, I hoped.

Ziyad wasn't around, which was too bad. I was actually
starting to warm up to the guy. His attitude wasn't the greatest, but he really
busted and got a lot done. Being a local resident, he got weekends. For me, it’s
6 months of hell. When I get home, I'll take a couple weeks off, then get back
to my job. For these guys… I mean, they live here, you know?

The next victim came in, helped by someone else, but
walking. He had been on his way to work. Yup. It was hands. Remove foreign
bodies. Stitch lacerations. Close wounds. Scrub. Smoke. Eat some breakfast
(some kind of bean dish and eggs). Another car pulled up and another victim
jumped out. I was scrubbing up when I heard the explosion. Two days in a row.
This isn't good. At least it’s earlier in my shift. Maybe I can go home on time
today.

It seemed like fewer victims this time, but it still seemed
like a never-ending stream. Remove foreign bodies. Stitch lacerations. Close
wounds. Scrub. I grabbed coffee, food, and energy drinks where I could. Remove
foreign bodies. Stitch lacerations. Close wounds. Scrub. I went home only an
hour late, feeling bad for the guys on the other shift. They had come in after
only three hours’ sleep. It all balances in the end, though. Or it doesn’t.
Keeping score is too hard, and we'd be trading shifts in another 2 weeks,
anyway.

The next day, Ziyad wasn't in again. I asked Eric about it.

He looked uncomfortable. Ziyad had been killed in the
explosion, he told me. The only one who had died in that explosion. Then it
made sense, kind of. Maybe helping all those other victims was his way of
making up for what he knew he'd do, just a little bit. I wondered about the other nurses, the
Syrians we were working with.

Doctors Without Borders. We're not supposed to be political – we just go in and
do what we can to put people back together. But how can we stay neutral in an
area where everything – your neighborhood, your faith, even your name – is political?
And how long before the hospital full of wounded Shi’ites and the doctors
trying to save them is itself a target?

Hopefully, it never will. In the
meantime, I've still got two more months. Remove foreign bodies. Stitch
lacerations. Close wounds. Scrub.

About Me

Five cats, two kids, one spouse, and a host of hobbies and interests that mostly take back-seat to school. I work and knit or spin, and if I'm lucky, I make time for writing, too. I like to cook, but do so rarely. I like soccer and hiking. I love the beach and I love warm, sunny days outside, but I also like cold rainy days with movies, knitting and soup.